Ensuring best practice

Medical education case study: educating HCPs in the use of a global assessment scale in rehabilitation

The Adult Arm Spasticity Interactive Resource was developed to educate healthcare professionals in the use of a Global Assessment Scale (GAS) to evaluate patients during a rehabilitation programme; set treatment goals; and measure their outcomes. It also details the use of botulinum toxin type A (BoNT-A) to treat such patients, injecting, dosing and includes details and video footage of five case studies.

The online resource was developed with the assistance of experts in adult spasticity, botulinum toxin injection, physiotherapy and utilisation of GAS, including Prof Lynn Turner-Stokes, Dr Jorge Jacinto, Prof Magid Bakheit and Stephen Ashford. It was also made available on CD-ROM at the end of 2009 in European and emerging markets.

The resource was developed with the assistance of a broad range of medical experts

ObjectivesSpasticity results from diverse aetiologies including stroke, trauma, multiple sclerosis and neoplasm involving the CNS. One symptom of adult arm spasticity is increased resistance to passive movement. If inadequately treated, patients may develop permanent contracture, deformity, pain, skin problems and more. This can have a dramatic negative impact on their quality of life, not only preventing them from working but even managing everyday tasks such as dressing and using cutlery. The aim of this resource is ultimately to improve the quality of life of such patients by encouraging a high standard of integrated care.

Treatment of adult arm spasticity requires a multidisciplinary approach including avoidance of triggering/aggravating factors (such as pain, tight clothing), physical therapy and splinting and medical treatments such as BoNT-A injections. The materials in this resource take into account this multidisciplinary approach.

One objective of this resource is to help physicians become familiar with the benefits of GAS when evaluating patients for treatment. Using GAS helps the physician working closely with patients to set realistic goals. Those goals can be scored so that the effectiveness of treatment can be measured. Such an approach makes the patients feel involved with their treatment, and have realistic expectations of that treatment. It also allows the physician to measure improvements in movement and dexterity following injections of BoNT-A.

Another objective is to share BoNT-A injection techniques with the aid of video case studies. This will enable physicians to consider the best treatment options for patients.

The overall objective of this interactive resource is to encourage best treatment practice for patients with adult arm spasticity. Consequently, this will have a positive impact on patients' care and hence, patients' quality of life.

TacticsThis resource will initially be used by Ipsen personnel to present a choice of interactive elements to physicians. As internet access may be an issue in some of the venues/countries, the resource will be provided on CD-ROM. The resource will also be made available to some opinion leader physicians as an educational tool. The different elements of this flexible resource can be presented as a whole or as individual sections as required, depending on the level of expertise of the audience.

In the resource, GAS is explained and the user is shown how to set goals for the patient and how to calculate appropriate GAS scores. Each patient has his/her own measurement for a specific outcome. As patients are scored in a standardised way, statistical analysis is facilitated. The process of agreeing goals promotes patient and carer involvement and such goals are more likely to be achieved if patients have been involved in their definition.

GAS can serve to organise and focus treatment, clarifying the aims of treatment. It is easily integrated into treatment practice.

CasestudiesFive patient case studies are included in this resource. Incorporated in the case studies is video footage to support the educational material:• Video footage of physician presenting the patient's history• Physician consultation with patient, developing and agreeing individual GAS goals• Footage of patients walking and/or completing tasks before treatment• Footage of BoNT-A injections.

In some cases, there was also footage of patients completing a task and/or walking at a follow-up consultation four weeks post-injection.

ResultsIt is intended that the resource will encourage the use of GAS when consulting with patients and that BoNT-A injectors will be better informed regarding the best muscles to inject and doses to use that will improve patient movement control and functionality, thus improving individuals' quality of life.

EvaluationAt a recent international meeting, initial feedback from over 200 opinion leaders on the benefits of using the resource was very positive. Further evaluation on the impact of the resource will be measured through feedback questionnaires. The feedback will enable the tool to be developed as an online dynamic resource.